Provider Demographics
NPI:1740469352
Name:SETH A. BERL, MD
Entity type:Organization
Organization Name:SETH A. BERL, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-890-1442
Mailing Address - Street 1:9 HOSPITAL PARK
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6772
Mailing Address - Country:US
Mailing Address - Phone:229-890-1442
Mailing Address - Fax:229-890-0782
Practice Address - Street 1:9 HOSPITAL PARK
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6772
Practice Address - Country:US
Practice Address - Phone:229-890-1442
Practice Address - Fax:229-890-0782
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SETH A. BERL, MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-31
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024390363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000253646DMedicaid
GRP3670Medicare PIN
D39396Medicare UPIN
GAGRP3670Medicare PIN